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Use of a double epidural catheter provides effective postoperative analgesia after spine deformity surgery

[L'utilisation d'un double cathéter péridural fournit une analgésie postopératoire efficace après une opération pour déformation de la colonne vertébrale]

Georgios Ekatodramis, MD^*, Kan Min, MD, Philipp Cathrein, MD and Alain Borgeat, MD^*

^* From the Departments of Anesthesiology, and
Orthopedic Surgery, Orthopedic University Hospital Zurich/Balgrist, Zurich, Switzerland.

Address correspondence to: Dr. Alain Borgeat, Chief of Staff Anesthesiology, University Clinic of Zurich/Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland. Phone: +41 1 386 11 11; Fax: +41 1 386 16 09; E-mail: aborgeat{at}balgrist.unizh.ch

Purpose: Spine deformity surgery is a painful procedure in which pain control is difficult to obtain. The aim of this study was to evaluate the efficacy of double epidural catheters in this setting.

Methods: Twenty-three patients scheduled for an elective spine deformity surgery were included prospectively. At the end of surgery, the surgeon inserted two epidural catheters, one cranial, one caudal to the surgical field. In the recovery room the catheters were both injected with a bolus of bupivacaine 0.0625%. In the absence of any neurological abnormality a continuous infusion of bupivacaine 0.0625%, fentanyl 2 µg•mL^-1 and clonidine 3 µg•mL^-1 was administered at a rate of 10 mL•hr^-1 through each catheter for 48 hr. Pain score, sedation level, motor block and side-effects were checked regularly.

Results: Complete analgesia (VAS=0) was obtained at rest in all patients. During mobilization and physiotherapy four patients (17%) had a VAS 30. No motor block was observed. Four patients (17%) had nausea and vomiting. No excessive sedation, pruritus or respiratory depression were observed. Early mobilization was possible in all patients.

Conclusion: Postoperative epidural analgesia by means of a double catheter is an effective technique to control pain after spine deformity surgery and is associated with a low incidence of side-effects.